States' Scorecard Finds Big Differences in Kids' Health Care

WEDNESDAY May 28, 2008 -- The quality of children's health care in America varies widely from state to state, as does their access to insurance and care and the likelihood of living long and healthy lives.

That's the conclusion of a new scorecard produced by the Commonwealth Fund, a private foundation that seeks to promote better health care for all Americans.

According to the scorecard, if all states performed as well as the top few states:

an additional 4.6 million children nationwide would have health insurance;

11.8 million more children would get their recommended yearly medical and dental check-ups;

10.9 million more children would have a "medical home" -- a regular source of care;

1.6 million fewer children would be at risk for developmental delays;

and nearly 800,000 more children would be up-to-date on their vaccines.

Iowa, Vermont, Maine, Massachusetts, and New Hampshire are the top performing states, according to the report, while Arizona, Florida, Louisiana, Mississippi, New Jersey, Nevada and Texas are at the bottom.

"States and the federal government have a very high stake in ensuring that children are healthy," Commonwealth Fund President Karen Davis said during a teleconference Tuesday. "In fact, more than one-third of children in the United States receive health care funded by the federal government as well as the 50 states and the District of Columbia."

The report, U.S. Variations on Child Health System Performance: A State Scorecard was released Wednesday.

There are 28 million children covered by Medicaid and 6 million covered by the State Children's Health Insurance Program (SCHIP), Davis noted. And the key to providing health care to children is insurance, Dr. Edward L. Schor, the Commonwealth Fund's vice president for child development and preventive care, said during the teleconference.

"In this study, we found a four-fold difference in the rates at which children are uninsured," Schor said.

The number of uninsured children varied widely across the states, from a low of 5 percent in Michigan to a high of 20 percent in Texas. States that had the most insured children tended to have the highest scores on quality of care, Schor said.

If all states performed as well as Michigan when it came to providing insurance, then 4.6 million more children would have health insurance, Schor said. "That would cut the rate of uninsured children in half," he said.

Using vaccinations as a measure of access to care, the scorecard again found substantial variation among the states, Schor said. "In Massachusetts, 94 percent of children were up-to-date on their immunizations, whereas in Nevada it was only 67 percent," he said.

Another key is having a "medical home" -- a regular source of care, Schor said. "Whereas 77 percent of children in New Hampshire had a medical home, in Mississippi, 34 percent had a medical home," he said. "We know that children who have a medical home have a better quality of care."

The scorecard took into account 13 indicators of children's health, including access, quality, costs, equity and the potential to lead a long and healthy life. While no state scored high on all categories, some regions surpassed others. For example, states in the Northeast and Upper Midwest often ranked higher in several areas, while the lowest rankings were in the South and Southwest, the report found.

Studies have shown that in states with high numbers of uninsured children, those children are less likely to get recommended health care, vaccines, dental care and regular checkups. These children are also at greater risk for developmental delays and infant mortality, Davis said.

But even in the highest-ranking states, quality of care falls short of goals, the report noted. In Massachusetts, the top-ranked state in quality, 75 percent of the children were seen by a doctor and a dentist in the past year, compared with only 46 percent of children in Idaho.

"One of the major efforts states can take to improve quality of care is to provide health insurance coverage to children, particularly low-income children," Davis said. "States that do a good job on that are among the states that are highest ranked on the various dimensions of quality of care. They are also the states that tend to do well on equity measures to help ensure that minority children and low-income children have better access to care and better quality of care".

One expert believes it's essential to increase funding for Medicaid and SCHIP to get more children covered by health insurance.

"We think this is a great report and it shows what we have been trying to show for a long time, which is how important Medicaid and SCHIP are to children's health," said Jenny Sullivan, a senior health policy analyst with the nonprofit, nonpartisan health care advocacy group Families USA. SCHIP legislation was enacted in 1997 to cover children in low-income families.